Children's Home run by London Borough of Brent in Brent

Inspection report children’s home: SC457780 1 SC457780 Registered provider: London Borough of Brent

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Full inspection Inspected under the social care common inspection framework

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Information about this children’s home

This short break service occupies purpose-built premises. A London local authority owns and manages the centre. The service is registered to provide short breaks for up to eight children and young people living with physical and/or learning disabilities and/or sensory impairment. This includes children and young people on the Autistic Spectrum.

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Overall experiences and progress of

children and young people, taking into account

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Outstanding

How well children and young people are helped and protected Outstanding

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Outstanding

The effectiveness of leaders and managers Outstanding

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Outstanding

The children’s home provides highly effective services that consistently exceed the standards of good. The actions of the children’s home contribute to significantly improved outcomes and positive experiences for children and young people who need help, protection and care.

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Outstanding

Date of last inspection: 19 January 2017

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Outstanding

Overall judgement at last inspection: Declined in effectiveness

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Enforcement action since last inspection

None Inspection report children’s home: SC457780 2

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Key findings from this inspection

This children’s home is outstanding because:

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Key findings from this inspection

 The registered manager and staff team are highly aspirational. They do not allow profound disabilities and complex medical conditions to limit their high ambitions for children and young people.  Children and young people make significant progress during their time at the home. Individual targets are monitored and reviewed closely.  A highly experienced registered manager drives the service forward with vigour and determination. Research-based practice and exceptional partnership working ensure that children and young people receive outstanding standards of care from a knowledgeable and effective staff team.  Excellent collaboration and communication with parents and carers and other care professionals are core strengths of the service. These enable care to be precise and well co-ordinated.  The children and young people are provided with care that is dynamic and adaptable, in accordance with the children’s and young people’s needs.

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Key findings from this inspection

 The registered manager is extremely resourceful, sourcing innovative, stimulating and varied activities both inside and outside the home. These activities significantly enhance the children’s and young people’s experiences during their short breaks.  The staff team provides consistent and highly personalised and individualised care of an outstanding quality. Detailed and comprehensive care plans and risk assessments provide staff with excellent guidance that they follow in practice. This approach, coupled with a focus on ensuring that the specific needs and preferences of the children and young people are identified and met, ensure that they receive safe and sensitive care.  The children and young people benefit from trusting relationships with the highly skilled and committed staff team.  Children’s and young people’s safety and welfare are given the highest priority. Leaders and managers take rapid and highly effective action to address any

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Key findings from this inspection

shortfall. This ensures that the well-being of children and young people remains paramount during their stay at the home.

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Key findings from this inspection

The children’s home’s areas for development:

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Key findings from this inspection

 Children’s and young people’s risk reduction strategies should receive written parental consent. Inspection report children’s home: SC457780 3

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Inspection date Inspection type Inspection judgement

19/01/2017 Interim Declined in effectiveness 01/09/2016 Full Outstanding 16/02/2016 Interim Sustained effectiveness 28/09/2015 Full Outstanding Inspection report children’s home: SC457780 4

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Recommendations

 Homes that care for children where, as a result of their impairment or disability, restraint is a necessary component of their care should include information relating to this in the behaviour management policy and statement of purpose. In particular, written parental consent must be sought for the use of bed side guards. (‘Guide to the children’s homes regulations including the quality standards’, page 47 paragraph 9.44)

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outstanding

The quality of care provided to the children and young people is excellent. Care plans are extremely clear and provide staff with the guidance they need to meet the specific needs of children and young people. All aspects of the children’s and young people’s needs are identified in considerable detail. Waking, eating, activities, medication, likes and dislikes, bedtime routines, behaviours, and risks are concisely observed and recorded during the children’s and young people’s stay at the home. This provides the children and young people with individualised care that meets their specific needs. Parents, carers and care professionals praise the impact that the quality of care has on improving the lives of children and young people. One parent states that her daughter, ‘had an amazing time. She has positively bounced home smiling, chatting and talking about the weekend.’ The parent went on to say, ‘It’s amazing how happy

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outstanding

and settled she is.’ A care professional said the staff have such good, warm relationships with children and young people. They added, ‘They really try to get to know the children’s likes and dislikes and accommodate their needs.’ Care professionals also compliment the registered manager and staff team for their commitment to the children and young people. The home’s staff regularly visit schools, and attend consultations and reviews. School staff note the positive joint working that exists between them and the home’s staff. School staff say, ‘Staff visit from the home and observe the child at school and we discuss behaviour support together. As a result, care planning is cohesive and enables the staff to provide the children and young people with a consistent level of care.’ Children and young people develop strong, meaningful and trusting relationships with staff. An excellent approach ensures that staff build up their knowledge about

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outstanding

the children and young people before they start staying at the home. For example, staff visit the children and young people at their own home or school. These vitally important observations and discussions with parents, carers and care professionals help to identify and plan bespoke packages of care. Children and young people are able to visit the home in a planned and sensitive way before their first overnight stay Inspection report children’s home: SC457780 5 takes place. For instance, children and young people experience teatime visits to the home with support from their parents/carers. A parent says, ‘We had a tea time visit for the whole family first, then M visited for tea time, and then stayed overnight. This was good planning.’ This approach helps to reassure the children and young people and allows them opportunities to become used to a new environment and the adults who will care for them.

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outstanding

Parents and carers confirm the outstanding quality of communication that exists between themselves and the staff team. For example, parents and carers contribute to the ‘home link book’. This simple but highly effective way of communicating ensures that an excellent level of relevant information is shared routinely. The home link book is a successful tool. It provides the staff team with updated children’s and young people’s essential information since their last visit to the home. The home link book includes key information regarding the children’s and young people’s emotional and physical needs, medication, new support equipment, changes to routine and any other relevant information. This provides the staff team with current information, which further informs the particular plan for the short break. A parent says, ‘The writing in the book is helpful’ and ‘communication is very good’. Another parent

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outstanding

states, ’I have always been able to talk to everybody who works with my son… I can go directly to talk with the manager at any time.’ This adaptable and dynamic approach ensures that the children and young people receive care tailored to meet their needs. The registered manager’s commitment to the children and young people reaches beyond the home. This ensures that parents and carers receive excellent support, guidance and encouragement to learn new skills to care for the complex needs of their children and young people. The home facilitates regular parents’ meetings and the registered manager invites other care professionals to attend. For example, the local authority special educational needs adviser recently attended. As a result, parents and carers are provided with crucial advice on the availability of community services. This further enhances their support and development and increases the life

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outstanding

chances of children and young people. Children and young people make outstanding progress during their short break stays. The registered manager and staff team proactively monitor the progress of the children and young people. Measurable targets for each child and young person are reviewed in detail during staff meetings and staff supervision. In addition, staff ensure that every aspect of progress is captured in the daily logs and care plans. Individual targets are considered carefully to ensure that they match the complex needs of the children and young people. Progress can be in small ways; however, for many children, young people and their families, these small steps are highly significant. The dedication and skill of staff have enabled one young person to progress during his short break visits from a reliance on staff to feed him to being able to hold a spoon to feed himself. Through the use of activity cards, the skilful

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outstanding

staff team supported a non-verbal young person to begin to make independent choices. For example, the young person is now able to choose between spending time in the garden or the sensory room. As a consequence, the young person is empowered and staff can easily facilitate his choices. Inspection report children’s home: SC457780 6 The specific progress of children and young people is tracked incrementally. This can include choosing their food, clothes or toys. A number of children and young people do this through non-verbal communication, such as the expression on their faces and extended eye contact between them and staff. Appropriate targets also assist children and young people to develop increased levels of independence skills. These include teeth brushing, staying seated during meal times, and eating a meal independently. The registered manager and staff team are embedding the person-centred active

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outstanding

support care approach. This approach supports children’s and young people’s independence skills development and their ability to make choices, and contributes to their care in the home. Another care professional said the staff team, ‘Take the time to know the child well.’ The highly skilled staff team has detailed knowledge of the children’s and young people’s verbal and non-verbal communication choices. This enables staff to understand the children’s and young people’s wishes and feelings and respond accordingly. For example, when a certain young person frowns, staff understand that this means that they are anxious and staff immediately respond by providing reassurance. Children and young people enjoy food preferences that meet their dietary and cultural needs. The chef is meticulous in preparing preferences such as Halal foods and specialist diets that are gluten free and suitable for those with lactose

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outstanding

intolerance. Menus are planned in advance of the children’s and young people’s short breaks. The registered manager and staff team work closely alongside parents and carers to ensure a consistent approach. For instance, parents and carers are invited to the home to advise the chef about any specific food preparation requirements. A parent’s recent visit provided the chef and staff team with an excellent opportunity to work together, so that the cooking style and portion size suitable for her son was known by all. The chef then replicates this. This provides the children and young people with a ‘home from home’ dining experience. Children and young people are regularly encouraged to express their views on the quality of care that they receive during their short break. Feedback questionnaires provide the children and young people with the opportunity to participate in the running of the home. Children and young people consistently write or sign that they

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outstanding

are supported, feel safe, receive help with their targets, enjoy activities and like their food and drink. Children and young people have their suggestions acted on. Most recently, this had led to trips to the zoo, bowling and the planning of summer parties. The home, purpose-built for children with profound and multiple disabilities, is impressive. Specialised equipment in all bedrooms, bathrooms and communal spaces promotes accessibility and inclusion for all children and young people who stay at the home. The home is clean and attractively decorated. Photographs of the children and young people enjoying their activities at home and in the community are displayed throughout the home. Brightly coloured walls and soft furnishings add to the child- friendly and homely environment. A few of the bedrooms are showing signs of some understandable wear and tear; these shortfalls do not impact negatively on the

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outstanding

Inspection report children’s home: SC457780 7 quality of care that is provided. Improvements are currently underway to improve the wall coverings. Children and young people enjoy access to a large garden with suitably adapted play equipment. A proactive approach to ensuring the safety of children and young people ensures that they are not exposed to unnecessary risks. The home has ready access to the adjoining school and benefits from a considerable amount of additional play equipment and outdoor space. Staff shift handovers are effective. Thorough discussions take place, which include updates on the current children’s and young people’s welfare; plans for the children and young people who are due to stay are shared and recorded in great detail. The depth of the information that is routinely shared enables the children and young people to receive seamless care. For children and young people with complex needs

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outstanding

in particular, this constancy of care supports their need for stability and security extremely well. Staff greet children and young people warmly on arrival. Staff prepare individual activity plans for the children and young people for their stay based on the children’s and young people’s preferences, abilities and current care needs. Children and young people are cared for through appropriately high levels of staff supervision. This ensures that they receive the care, support and intervention necessary to meet their needs. For example, a young person who had had a long and busy day was enabled to relax in the sensory room. Another young person and staff member enjoyed floor play with cushions, while another young person was enjoying supervised play in the garden. Children and young people are provided with fun and stimulating learning opportunities. The dynamic staff team implements creative strategies to support

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outstanding

learning. For instance, a box containing sensory toys is readily available for the children and young people. This extremely effective approach assists children and young people to learn to take turns, make choices, improve motor skills, and discover different textures. Children and young people enjoy regular experiences in the home that support their individual and complex needs. Quiet time or sensory stimulation in the home’s sensory and relaxation rooms provides the children and young people with specialised support. Simple interactions, such as the gentle stroking of a young person’s hand, significantly helps them to calm and relax. The staff team’s exceptional knowledge of the individual children’s and young people’s communication styles supports wishes and feelings to be efficiently responded to. This was evidenced clearly when a young person’s gesture of tiredness, indicating that they wanted to spend time in the sensory room, was acted

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outstanding

on swiftly by staff. This meant that they settled quickly and did not become agitated or anxious. Children and young people have fun in and out of the home. Activities are numerous and include trips to museums, visits to enjoy ice skating, the fun fair, the seaside, arts and crafts exhibitions, joining in gardening, hair and beauty sessions, birthday Inspection report children’s home: SC457780 8 parties, board games, face and hand painting, beading, cooking and baking. In addition, musical instruments offer the children and young people enjoyable experiences that further develop their learning and participation. A member of staff said, ‘We give the children the same experiences as other children.’ Creative and innovative activity planning enriches the children’s and young people’s experiences during their stay at the home. Experiences are enhanced with contributions from outside sources. Excellent networking has led to a number of

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outstanding

outstanding links between the home and community-based partnerships. The national citizen’s service programme volunteers visit the home and provide the children and young people with opportunities to engage in drama, sport and gardening. In addition, the local scout group supported the children and young people with Christmas activities. A sport and media celebrity, whose name endorses the home, actively supports the children and young people and acts as a positive role model. Due to such positive relationships, the staff and children at the home have been invited to attend the World Para-Athletics Championships this summer. This will enable the children and young people to enjoy a unique experience.

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outstanding

Children and young people are safe and protected from neglect, harm and abuse. The registered manager is steadfast in her approach to providing a safe service to the children and young people. For example, when errors were identified in the administration of medication, the registered manager took robust and effective action to prevent them reoccurring. In addition, the head of service reinforced the home’s safeguarding standards directly with the staff team. As a result, the staff team received specialist pharmacist refresher training in medication recording and administration. Detailed staff guidance, policy and procedures have been updated. These documents clarify medication administration procedures and checking medications in and out of the home. This includes mandatory contact with parents and carers prior to the children’s and young people’s breaks to discuss any notifiable changes to their medication. Although the shortfalls did not place children or young

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outstanding

people at significant risk of harm, the registered manager’s precise and rapid actions meant that there have been no further incidents of concern. Children’s and young people’s care plans and risk assessments are regularly reviewed. Staff take account of the children’s and young people’s development and changing needs, which informs highly personalised care planning. Individual risk assessments and personal evacuation plans are exceptionally comprehensive and provide the staff team with concise detail regarding risks and strategies to reduce them. Staff know how to keep the children and young people safe from harm. All bedrooms are suitably equipped for the differing needs of the children and young people. Hoists, bed sides, epilepsy monitors and door alarms are provided, dependent on assessed risk. Waking night staff monitor all children’s and young people’s welfare during the night. Individual care plans identify risks in the physical

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outstanding

environment and appropriate measures to keep the children and young people safe Inspection report children’s home: SC457780 9 and secure. However, not all of the care plans regarding the use of bed sides are signed by parents. This shortfall does not place children and young people at risk of harm. The errors were acknowledged by the registered manager, who took swift actions to start to rectify them. The registered manager and staff team are not risk-averse. Activities in the community are thoroughly risk assessed. Checklists are completed before any outing. Children’s and young people’s individual risks are assessed prior to every activity. The knowledgeable staff team takes account of each child’s and young person’s needs and vulnerabilities. Staff take meticulous care when planning staffing levels and risk reduction actions. The children and young people are kept safe without limiting their participation in events inside the home and in the local

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outstanding

community. As a result, they benefit from the extensive planned community activities which broaden their horizons. Children and young people do not go missing when staying at the home. Training supports staff in all aspects of safeguarding vulnerable children and young people. There have been no restraints or sanctions recorded since the last full inspection. Physical restraint and sanctions are rarely used. High-quality behaviour management plans record ‘triggers and environments’ that may cause children and young people emotional or physical distress. Individual support and intervention strategies are recorded. Behaviour support strategies are shared and agreed between parents and staff. These enable the children and young people to receive a consistent approach to care. The child and adolescent mental health service (CAMHS) regularly communicates with the registered manager and staff team. As a result CAMHS deliver a six-week

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outstanding

programme for parents to enhance their behaviour management knowledge. This further enhances parents’ and the staff team’s knowledge in providing the children and young people with safe support. Staff have a thorough understanding of the child protection policies and are confident about how to report any concerns or allegations made. This promotes the children’s and young people’s safety. Any complaints are addressed swiftly. One complaint has been made since the last inspection. The home’s recording policy and procedure are followed and referral to the designated officer is made when appropriate. The updated children’s guide is available to the children and young people in written and pictorial form. Training is given prominence and ensures that children and young people with complex needs can access the service. All staff receive statutory training and specialised training to meet the specific needs of the children and young people.

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outstanding

Examples include safeguarding children, autism approaches, hoist and manual handling, diabetes, epilepsy and gastrostomy feeding. All training is regularly refreshed in line with guidance. This provides the children and young people with a consistently professional level of safe care. Some of the children and young people have complex medical needs. Staff communicate regularly with medical professionals and attend the children’s and Inspection report children’s home: SC457780 10 young people’s medical consultations. This provides the staff team with the most up- to-date medical care arrangements for the children and young people. A medical professional said, ‘The staff are very approachable and communication is good.’

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The effectiveness of leaders and managers: outstanding

Leadership and management are excellent. The registered manager and staff team work effectively together to provide the children and young people with exceptional individualised care and experiences. A parent complimented the registered manager and staff team by saying, ‘You have a wonderful and dedicated team.’ The registered manager is a highly skilled and knowledgeable practitioner. Her extensive qualifications and experience of working with children and young people with disabilities have built a confident and well-informed staff team. The registered manager’s continuing professional development informs the development of the service. She shares any new knowledge with the staff team. The registered manager’s training as a registered nurse in specialised feeding techniques enhances the team’s highly specialised knowledge base. Staff training in a person-centred active support model of care illustrates the registered manager’s commitment to

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The effectiveness of leaders and managers: outstanding

provide the staff team with expert skills. Such an approach provides the children and young people with increasingly excellent levels of highly effective and safe levels of care and support. The registered manager is highly ambitious in developing staff learning and practice. She ensures that the entire staff team is well qualified and encouraged to develop further. The vast majority of care staff already hold the NVQ level 3 childcare qualification. However, the registered manager’s unquestionable commitment to staff development has seen her ensure that all of the staff are now enrolled to undertake the newer qualification of the level 3 diploma in residential childcare. This is a significant undertaking and one that confirms the excellent approach in supporting and guiding staff to develop and improve their knowledge and practice. Regular formal supervision provides the staff with excellent levels of support. Time is

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The effectiveness of leaders and managers: outstanding

set aside for reflective discussion about the children and young people. Staff opportunities to reflect and share ideas on the effectiveness of support and interventions for the children and young people are productive. This enhances the quality of care for the children and young people. The registered manager is highly active and resourceful in developing the service further. She arranges regular meetings with the local authority children with disabilities team and the adult transition team in order to share practice information. Specialist professionals deliver presentations at the staff team meetings. Experts regularly attend the home to provide staff with the latest advice, guidance and examples of best practice. For example, the local authority oral hygiene specialist for children with disabilities, staff from CAMHS, and a play therapist are routinely invited to attend staff meetings. This proactive approach means that the staff enhance their

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The effectiveness of leaders and managers: outstanding

knowledge and abilities to provide optimum care. The registered manager and staff team are committed to providing exceptional care Inspection report children’s home: SC457780 11 to the children and young people. Robust and far-reaching monitoring systems are in place. The external independent visitor visits the home once a month. The subsequent reports are detailed and highlight areas of strength, good practice and constructive advice for improvements. The registered manager swiftly actions any recommendations and appropriately utilises the process to maintain outstanding standards of care. The registered manager displays a comprehensive appreciation of the strengths and weaknesses of the home. She completes regular reviews of the home’s quality of care. Monitoring and progress against the quality standards are comprehensive, with detailed actions plans drawn up to further embed the exceptional care offered to the

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Information about this inspection

Inspectors have looked closely at the experiences and progress of children and young people. Inspectors considered the quality of work and the difference made to the lives of children and young people. They watched how professional staff work with children and young people and each other and discussed the effectiveness of help and care provided. Wherever possible, they talked to children and young people and their families. In addition, the inspectors have tried to understand what the children’s home knows about how well it is performing, how well it is doing and what difference it is making for the children and young people who it is trying to help, protect and look after.

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Information about this inspection

Using the ‘Social care common inspection framework’, this inspection was carried out under the Care Standards Act 2000 to assess the effectiveness of the service, how it meets the core functions of the service as set out in legislation, and to consider how well it complies with the Children’s Homes (England) Regulations 2015 and the ‘Guide to the children’s homes regulations including the quality standards’. Inspection report children’s home: SC457780 12

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Children’s home details

Registered provider address: Brent Civic Centre , Engineers Way , Wembley , London, HA9 0FJ

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Inspector

Victoria Jones, social care regulatory inspector Inspection report children’s home: SC457780 13 achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children’s social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children’s services, and inspects services for children looked after, safeguarding and child protection.

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Inspector

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Inspector

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Inspector

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